A pterygium is a triangular growth of pink, fleshy tissue on the eye. It usually forms on the side closest to your nose and grows toward the pupil area. A pterygium usually has no symptoms and most patients come to the doctor when they notice the growth. Sometimes wind or dust or inflammation can cause irritation or tearing in the eye. If the growth gets into your cornea, it can cause blurry vision.
 
Cause
A pterygium can be caused by excessive exposure to ultraviolet light from the sun or irritants like dust, wind, smoke, or heat. At first a pinguecula might form and after exposure to light may cause the tissue and blood vessels to form a pterygium.
 
Diagnosis
The doctor may perform a slit lamp examination to accurately assess the size and extent of the pterygium.
 
Prevention
Avoid irritants like wind, sunlight, dust, and smoke, including cigarette smoke. Wear sunglasses regularly when you are outside to protect against the sun and wind.
 
Treatment

1. Prevention is the best treatment so avoid irritants that can cause inflammation by wearing sunglasses when outdoors and avoid being outside too long when it’s very sunny or windy.
2. Use eye drops to alleviate symptoms of pinguecula or pterygium, such as irritation, tearing, and/or redness. Your doctor will prescribe eye drops as appropriate to manage these symptoms. Eye drops cannot eradicate pinguecala or pterygium, but when the inflammation is reduced and preventive measures are practiced, the tissue can improve somewhat.
3. Pterygiums do not usually need to be treated as they are not dangerous and do not usually impact vision. But in some patients, if symptoms affect the quality of life or the pterygium affects self-esteem, surgery may be an option. Surgery may also be considered if eye drops do not help reduce irritation.

1. To reduce chronic irritation and inflammation.
2. To treat irritation and inflammation that are not managed with eye drops.
3. To prevent impact on vision due to the pterygium.
4. To improve self-esteem.

1. Wash your hair before the procedure.
2. Do not wear makeup or apply any powders, lotions, or perfumes on the day of the procedure.
3. If local anesthesia is used, you can have a light meal before the procedure.
4. Please let the doctor know about all medication that you are taking as some may need to be stopped before the procedure, especially blood-thinning medication.
5. Use any eye drops prescribed by your doctor before the procedure.

The doctor can remove the pterygium permanently by excising the growth from underneath where it originates, giving the eye a smoother appearance. Blood vessels are then cauterized using a microscope.
 
Methods of Excision

1. The traditional method of excision removes the pterygium from the cornea and the root of the pterygium that is implanted on the outer surface that surrounds the eye will also be removed. The tissue at the edge of the incision is usually thick, so the doctor will trim it down so it is thinner.
2. The traditional method of excision along with a graft may be done where tissue from another part of the eye is used to cover the open wound to prevent recurrence.
3. The traditional method of excision along with using prepared and preserved amniotic membrane as a graft instead of eye tissue to prevent recurrence.
4. The traditional method of excision with placement of beta particles to prevent recurrence.

Whichever method is used, if the pterygium is very small, especially in elderly patients, the doctor usually will not perform a graft. The surgical method used will be determined by the doctor as appropriate for each patient.

1. After the procedure, it is important that you carefully follow your doctor’s instructions. The doctor will prescribe eye drops to use after the procedure. Be sure to use them regularly as prescribed to prevent inflammation and infection.
2. Avoid exposure to wind and sunlight by limiting outdoor activities and limit time spent looking at a computer screen, watching television, and reading. Wear sunglasses when you are outside to protect your eyes from wind and sunlight to reduce the risk of recurrence.
3. Approximately 7-10 days after the procedure the doctor will remove the sutures placed and provide information about preventing recurrence.
4. In the first month after the procedure you may notice more blood vessels in the affected eye than normal, making the eye look quite red. This is normal. It can cause some discomfort. Wear sunglasses to protect the eye from wind and light and be sure to use artificial tears to lubricate the eye and prevent irritation.
5. Since there are many factors that can lead to recurrence, be sure to discuss these factors in detail with your doctor. If you notice a recurrence, see your doctor immediately.

There is always the risk of recurrence even after the procedure. Possible complications include inflammation and/or infection. The pterygium can impact vision if it grows very close to the pupil. Avoid irritants as much as possible and be sure to lubricate the affected eye well for at least six weeks after the procedure.
 

Before the Procedure

• Please plan to stay in Thailand for at least one week through the duration of the treatment.
• It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure.

After the Procedure

• After the procedure your eye(s) will be covered for at least one day. A family member or friend should come with you to the hospital and accompany you home.
• You will return for a follow-up appointment the next day. If you have no abnormal symptoms, you can travel back to your home country, depending on your doctor’s recommendations.
• Please return for follow-up appointments regularly after the procedure. The first appointment should be one month after the procedure and then the following month, after three months, and then after six months. If you are unable to travel to Thailand, please see an ophthalmologist in your country.

 

The risk of recurrence is approximately 30% in patients who undergo excision with graft. Recurrence is approximately 5% (Nuzzi R & Tridico F, 2018) with excision and amniograft or beta particles. Recurrence depends on post-procedure care and avoiding irritants like sunlight, wind, dust, and smoke.
 
What if the procedure is not performed?
Patients with mild pterygium may experience some redness where the growth is and feel some irritation when the eye is exposed to sunlight or wind or if they use the eye too much (when looking at the computer or television or while reading). This can usually be managed with eye drops.

In more severe cases, the pterygium may extend into the iris and the thicker the pterygium is, the more it will irritate the tissue of the eye. This may also be managed temporarily with eye drops, but when the eye is exposed to irritants, the symptoms usually worsen.
 

You may wear sunglasses that offer more protection when exposed to light or wind. Eye drops should be used regularly if you experience red eyes and artificial tears can keep the eye well lubricated. Artificial tears are also usually gentle for the eye. If you avoid irritants and use eye drops and still struggle with irritation, stronger medication may be required to prevent inflammation. Otherwise the capillaries of the eyes may become permanently altered. The doctor may treat this with a laser. However, in these cases, surgery may be the best option for a permanent result.